利多卡因表面麻醉对小儿扁桃体切除术后镇痛及应激反应的影响

Effects of lidocaine surface anesthesia on postoperative analgesia and stress reactions of children receiving tonsillectomy

目的探讨利多卡因表面麻醉对小儿扁桃体切除术后镇痛及应激反应的影响。方法 2012年9月至2014年5月甘肃省皋兰县人民医院收治小儿扁桃体切除术患儿86例,随机分为观察组和对照组各43例。对照组患儿在常规麻醉的基础上给予生理盐水创面喷洒,观察组患儿给予利多卡因表面麻醉。观察并记录两组患儿药物喷洒后、患儿清醒后即刻、10min、30min以及60min的血压、心率、呼吸、动脉氧饱和度(SaO_2)以及疼痛评分,并通过观察两组术前和术后促肾上腺皮质激素(ACTH)、白细胞介素6(IL-6)、皮质醇(COR)水平变化,分析患儿应激反应。结果两组患儿药物喷洒后和清醒后60min的血压、心率、呼吸、SaO_2以及疼痛评分等各项指标比较差异无统计学意义(P>0.05),而患儿清醒后即刻、10min、30min观察组患儿血压、心率、呼吸、SaO_2均低于对照组,差异有统计学意义(P<0.05);术前两组患儿ACTH、IL-6、COR等指标比较差异无统计学意义(P>0.05),术后观察组患儿的各项指标均优于对照组,差异有统计学意义(P<0.05)。结论应用利多卡因表面麻醉能够明显降低小儿扁桃体切除术后镇痛和应激反应程度,具有非常显著的改善效果。

Objective To explore the effects of lidocaine surface anesthesia on postoperative analgesia and stress reactions of children receiving tonsillectomy. Methods A total of 86 cases of children receiving tonsillectomy in our hospital from September 2012 to May 2014 were selected as the research subjects, who were divided into observation group and control group according to the random number table method, with 43 cases in each group. On the basis of routine anesthesia, the control group was given normal saline wound spray, and the observation group was given lidocaine surface anesthesia. The blood pressure（BP）, heart rate（HR）, respiration（RR）, arterial oxygen saturation（SaO2 ） and pain scores of children in the two groups after drug spraying, immediately after waking, after 10 rain, 30 rain and 60 rain of waking, were observed and recorded, and the stress reactions were analyzed by observing the adrenal cortical hormone（ACTH）, in- terleukin-6（lL-6） and cortisol（COR） levels in the two groups before and after operation. Results There were no significant differences in the levels of BP, HR,RR,SaOz and pain scores between the two groups after drug spraying and after 60 min of waking（P〉0.05） ,but observation group was significantly lower than the control group in those indexes immediately after waking, after 10 rain, and 30 rain of waking（P〈0.05）. There were no significant differences in the levels of ACTH, IL-6 or COR in the two groups before operation（P〉0.05） ,but the observation group was better in these indexes than the control group after operation（P〈0.05）. Conclusion The application of lidocaine surface anesthesia can significantly reduce the degree of pain and stress reactions after tonsillectomy, which has very significant improvement effects.